Congenital urinary tract obstruction

Best Pract Res Clin Obstet Gynaecol. 2019 Jul;58:78-92. doi: 10.1016/j.bpobgyn.2019.01.003. Epub 2019 Jan 11.


Congenital bladder neck obstruction (or lower urinary tract obstruction [LUTO]) describes a heterogeneous group of congenital anomalies presenting with similar prenatal ultrasonographic findings of dilated posterior urethra, megacystis, hydronephrosis, oligohydramnios and often with associated renal dysplasia. Untreated LUTO has high rate of perinatal morbidity and mortality from associated pulmonary hypoplasia and early-onset renal failure in infancy. Ultrasonographic features and prospective fetal urinalysis may help in predicting the overall prognosis of congenital LUTO. Currently, fetal vesicoamniotic shunt (of various designs), and fetal cystoscopy and fulguration of the obstruction are potential prenatal interventions. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated these treatments may possibly improve perinatal survival. Despite this, concerns remain as to the high rates of renal impairment observed in paediatric survivors. A clinical prospective scoring/staging system may improve prenatal diagnostic criteria and case selection for fetal therapy.

Keywords: Congenital abnormalities; Fetal therapy; Prenatal ultrasonography; Urinary bladder neck obstruction.

Publication types

  • Review

MeSH terms

  • Female
  • Fetal Diseases / diagnostic imaging
  • Fetal Diseases / epidemiology
  • Fetal Diseases / surgery*
  • Fetal Therapies / adverse effects
  • Fetal Therapies / methods*
  • Humans
  • Infant, Newborn
  • Male
  • Pregnancy
  • Treatment Outcome
  • Ultrasonography, Prenatal
  • Urinary Bladder Neck Obstruction / congenital
  • Urinary Bladder Neck Obstruction / diagnostic imaging
  • Urinary Bladder Neck Obstruction / mortality
  • Urinary Bladder Neck Obstruction / surgery*